The treatment decision under uncertainty: The effects of health, wealth and the probability of death

The Neural Response Process of Cognitive Decision Making: An ERP Study

Cognitive decision has the basic characteristics of risk avoidance and benefit seeking. To explore the neural response process of cognitive decision making, we asked 32 undergraduates to make a decision on whether to accept a specific treatment option with a certain cure rate and a certain risk rate while recording their electrical brain responses. The results showed that more participants chose the treatment option with a high cure rate and moderate or low risk. Compared with low and high risk, medium risk produced greater N1 and smaller P300. Low risk produced larger LPP than the moderate risk in the left hemisphere. The right prefrontal region appeared to have a smaller LPP for low risk than for high risk. The results suggest that individuals prioritize risk when making cognitive decisions. In addition, in medium-risk conditions, solution integration is more difficult. The effect of benefit size appears at the late stage of cognitive decision making and adjusts the effect of risk. These results support the satisfaction principle of decision making.

Effects of Public and External Health Spending on Out-of-Pocket Payments for Healthcare in Sub-Saharan Africa

Financing healthcare in Sub-Saharan Africa (SSA) is characterized by high levels of out-of-pocket (OOP) payments for healthcare. This renders many individuals vulnerable to poverty and deviates from the Universal Health Coverage (UHC) goal of providing financial protection for healthcare. We examined the relative effects of public and external health spending on OOP healthcare payment in SSA. We used the system generalised method of moments (GMM) estimator and data from the World Bank's World Development Indicators for 43 SSA countries from 2000 to 2017. The results show reductions in OOP payments are higher with increases in public spending than external spending. This means increases in public health spending, compared to external health spending, will increase the pace towards achieving the financial protection goal of UHC in SSA. But since government spending is limited by fiscal space and parliamentary approval, public health spending through social health insurance might provide a regular means of financing healthcare to speed up achieving the financial protection goal in SSA countries.

Decision thresholds with genetic testing

A genetic test is a test for the presence or absence of a genetic mutation. A positive test outcome that reveals a mutation associated with increased risk for a disease may lead a patient to seek preventive treatment provided that the penetrance (probability of developing the disease given the mutation) is sufficiently high. We derive the test threshold and the test-treatment threshold, which confine the mutation probability interval for the use of the genetic test. Test and treatment costs as well as a low penetrance rate of the mutation narrow this interval. We illustrate the model with parameters of the test for BRCA1 and BRCA2 genes as well as of preventive treatment options for breast cancer.

Multivariate risk preferences in the quality-adjusted life year model

The interest in multivariate and higher-order risk preferences has increased. A growing body of literature has demonstrated the relevance and impact of these preferences, but for health the evidence is lacking. We measure multivariate and higher-order risk preferences for quality of life (QoL) and longevity, the two attributes of the Quality-Adjusted Life Year (QALY) model. We observe preferences for a positive correlation between these attributes and for pooling together a fixed loss in one of the attributes and a mean-zero risk in the other, and for pooling together mean-zero risks in QoL and longevity. The findings indicate that higher-order risk preferences are stronger for health than for money. Furthermore, we test if preferences for a risky treatment for a disease affecting only QoL, depend on life expectancy. We find no such a relation, but there is a positive relation between riskiness of a comorbidity affecting life expectancy and risk aversion for a QoL treatment. We therefore observe no definitive deviation from the QALY model, although the model is more robust when expected longevity is high. Our findings suggest that the current practice of cost-effectiveness analysis should be generalized to account for risk aversion in QoL and longevity, and higher-order preferences.